Stevens- Johnson syndrome: case presentation

2003 ◽  
Vol 27 (1) ◽  
pp. 71-76 ◽  
Author(s):  
K. Donta –Bakoyianni ◽  
A. Mitsea ◽  
K. Deodoropoulou-Papadimitriou
Keyword(s):  
Erythema Multiforme ◽  
Clinical Manifestations ◽  
Stevens Johnson Syndrome ◽  
Ocular Involvement ◽  
Oral Lesions ◽  
Cutaneous Lesions ◽  
Case Presentation ◽  
Course Of Disease ◽  
Johnson Syndrome ◽  
Clinical Disorders

Erythema Multiforme (EM) is a rare mucocutaneous disease with a variety of clinical manifestations. EM it was recognized in the early 1800's, and still the etiology is unknown. It has been recently suggested erythema multiforme (EM) major and Stevens-Johnson Syndrome (SJS) could be separated as two distinct clinical disorders with similar mucosal erosions, but different patterns of cutaneous lesions. In particular SJS should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that appear on erythematous or purpuric maculae, which are different from classic targets. In SJS mouth, eyes, skin, genitalia and occasionally the esophagus and respiratory track may be affected. Oral lesions may cause severe pain and usually lips may become encrusted. Concerning ocular involvement, if there is conjunctivitis or uveitis this may lead to scarring and blindness. Also, the course of disease and the prognosis are in most cases severe.

Atypical Stevens-Johnson syndrome-like reaction in the setting of immune checkpoint inhibition.

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 102-102
Author(s):  
Gabriel E. Molina ◽  
Zizi Yu ◽  
Ruth K. Foreman ◽  
Kerry Lynn Reynolds ◽  
Steven T. Chen
Keyword(s):  
Immune Checkpoint ◽  
Clinical Course ◽  
Checkpoint Inhibitors ◽  
Clinical Manifestations ◽  
Stevens Johnson Syndrome ◽  
Ocular Involvement ◽  
Drug Eruptions ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
Epidermal Necrosis

102 Background: Stevens-Johnson syndrome (SJS) is a rare, life-threatening mucocutaneous toxicity that can occur in patients receiving immune checkpoint inhibitors (ICIs). ICI-induced SJS is scarcely reported in the literature and thus remains poorly understood, particularly regarding features that may distinguish it from classic SJS. Methods: To describe the timing, clinical manifestations, and treatment course of ICI-induced SJS, this multicenter, retrospective study identified seven patients with SJS in the setting of ICI use from January 2011 through May 2019. Results: All seven patients presented initially as benign, limited drug eruptions after a median of 4 ICI cycles (range, 1-7) and 63 days (range, 13-253 days) from ICI initiation. While none of the patients had prior drug allergies, all 7 were receiving new, recently initiated – i.e., within two months – medications at the time of rash onset. Cases demonstrated characteristic histologic findings of SJS, such as epidermal necrosis, and occasional unusual features, including interface dermatitis. All patients responded favorably and rapidly to systemic therapy, primarily intravenous corticosteroids, with near immediate symptomatic resolution and cessation of progressive skin blistering or detachment. Median length of stay was 11 days and no patients died from SJS. Conclusions: Our cohort defines an atypical SJS-like reaction secondary to ICI use, which is distinct from classic SJS in its delayed onset, mild initial presentation, and rare ocular involvement. The association with concomitant medication use suggests a potential mechanism whereby ICIs reduce patient immune tolerance to subsequent drug exposures. Reassuringly, this atypical SJS-like phenomenon exhibits a benign clinical course and favorable response to standard treatments.

scholarly journals Mycoplasma pneumoniae-induced rash and mucositis: A new entity

2021 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
Mohamed Ben Rejeb ◽  
Mouna Ben Hammouda ◽  
Mouna Korbi ◽  
Hichem Belhadjali ◽  
Adnene Toumi ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Erythema Multiforme ◽  
Community Acquired Pneumonia ◽  
Stevens Johnson Syndrome ◽  
Cutaneous Lesions ◽  
Drug Induced ◽  
Histological Features ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Epidermal Necrosis

Mycoplasma pneumoniae is a well-known cause of community-acquired pneumonia, mostly associated with dermatological manifestations especially with mucosal involvement and targetoid cutaneous lesions. For many years, it was considered among the spectrum of erythema multiforme. Recently, some authors have recommended the creation of a new syndrome called “mycoplasma-induced rash and mucositis.” This new syndrome has distinct epidemiological, clinical and histological features making it different from drug-induced Stevens-Johnson syndrome, toxic epidermal necrosis and erythema multiforme. Herein, we report two patients with acute Mycoplasma pneumoniae respiratory tract infection presenting severe mucocutaneous lesions in accordance with this new syndrome.

scholarly journals Erythema Multiforme: A Recent Update

2018 ◽  
Vol 11 (1) ◽  
pp. 167-170
Author(s):  
Shamimul Hasan ◽  
Jogender Jangra ◽  
Priyadarshini Choudhary ◽  
Silpiranjan Mishra
Keyword(s):  
Erythema Multiforme ◽  
Oral Lesions ◽  
Self Healing ◽  
Cutaneous Lesions ◽  
Treatment Protocols ◽  
Johnson Syndrome ◽  
Symptomatic Management ◽  
History Of ◽  
Steven Johnson Syndrome ◽  
Simplex Virus

Erythema multiforme (EM) is an acute, self-healing inflammatory mucocutaneous disorder which presents with diverse spectrum of cutaneous lesions, hence termed “multiforme”. Oral lesions are quite characteristic and manifest as rapidly rupturing vesicles & bullae forming ill-defined erosions and hemorrhagic encrusted lip lesions. Wide variety of triggering factors for EM have been documented in the literature, but history of prior herpes simplex virus (HS) infection is most widely accepted. Most other cases are seen after the intake of certain medications. EM has been chiefly divided into two main forms- EM minor and EM major. Steven Johnson syndrome & Toxic epidermal necrolysis (Lyell’s disease) are now considered as distinct clinical entities. EM has a self-limiting course and the lesions usually resolve within few weeks. Symptomatic management along with recognition and alteration of the alleged precipitating factors is usually sufficient in the majority of cases. However, in advanced lesions, steroid therapy may be helpful. This paper aims to present a recent update on Erythema Multiforme taking into account its etiopathogenesis, clinical and oral features, diagnostic aids and treatment protocols.

Warning against long-acting sulphonamides

1966 ◽  
Vol 4 (4) ◽  
pp. 13-13
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Erythema Multiforme ◽  
The United States ◽  
Stevens Johnson Syndrome ◽  
Warning Letter ◽  
Johnson Syndrome ◽  
The Us ◽  
Mucous Membranes ◽  
Long Acting

Last month the US Food and Drug Administration required American manufacturers of long-acting sulphonamides (sulphamethoxypyridazine, Lederkyn - Lederle and Midicel - PD; sulphadimethoxine - Madribon - Roche) to warn prescribers that in rare cases the Stevens-Johnson syndrome may develop as a severe and sometimes fatal side effect. This syndrome is a type of erythema multiforme in which large blisters appear on the skin and especially on the mucous membranes. The manufacturers were also to advise doctors ‘to consider prescribing short-acting sulphonamides first because they are effective for most of the same conditions’. The three drug firms concerned accordingly sent a joint warning letter to all doctors, pointing out that the Stevens-Johnson syndrome is a serious complication with a mortality rate of about 25%. So far 116 cases of this syndrome have been reported in association with the use of long-acting sulphonamides, most of them in the United States. Almost two thirds of the patients were children.

Head and Neck Manifestations of Erythema Multiforme in Children

1994 ◽  
Vol 111 (3P1) ◽  
pp. 236-242 ◽  
Author(s):  
Michael G. Stewart ◽  
Newton O. Duncan ◽  
Daniel J. Franklin ◽  
Ellen M. Friedman ◽  
Marcelle Sulek
Keyword(s):  
Oral Cavity ◽  
Toxic Epidermal Necrolysis ◽  
Head And Neck ◽  
Erythema Multiforme ◽  
Medication Use ◽  
Stevens Johnson Syndrome ◽  
Striking Increase ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Mucous Membranes

Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are related disorders of skin and mucous membranes, which are typically associated with antecedent medication use or infection. We review 108 cases of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis from Texas Children's Hospital, Houston, Texas, from 1981 to 1991, and illustrate the characteristic skin and mucosal lesions. In addition, we describe in detail two unusual cases requiring intensive airway management. Head and neck manifestations were present in 4 of 79 patients (5%) with erythema multiforme and 26 of 28 patients (93%) with Stevens-Johnson syndrome. In Stevens-Johnson syndrome, mucosal involvement of the lip (93%), conjunctiva (82%), oral cavity (79%), and nose (36%) were most common. Antecedent medication use was identified in 59% of erythema multiforme patients and 68% of Stevens-Johnson syndrome patients. We note a striking increase in the number of cases in our series caused by cephalosporins. Fifty percent of Stevens-Johnson syndrome patients required supplemental hydration or alimentation because of the severity of the oral cavity involvement. The head and neck mucosal manifestations largely respond to local care, and the routine use of prophylactic antibiotics or systemic steroids is not recommended.

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